Allogeneic hematopoietic cell transplantation outcomes for children with B-precursor acute lymphoblastic leukemia and early or late BM relapse

Abstract

Large registry studies have shown superior disease-free survival (DFS) with matched sibling donor (MSD) allogeneic hematopoietic cell transplantation (allo-HCT) over chemotherapy alone for patients with B-precursor acute lymphoblastic leukemia (ALL) and a late BM relapse. As most of these patients will not have an MSD, the decision to pursue an unrelated allo-HCT in second remission (CR2) or await a future relapse and perform HCT in third remission (CR3) continues to be debated. Between 1990 and 2006, 41 children with relapsed B-precursor ALL received a myeloablative allo-HCT at the University of Minnesota. Graft sources consisted of matched related donor (n ¼ 11), matched unrelated donor (n ¼ 9), and unrelated umbilical cord blood (n ¼ 21). Before allo-HCT, 15 patients had an early relapse (o36 months from diagnosis) and 26 had an initial late relapse (X36 months from diagnosis). In all, 30 patients (73%) were in CR2 and 11 were in CR3 (27%) at time of allo-HCT. Five year OS/DFS were similar for patients with an early or late marrow relapse, but there was inferior DFS among late-relapse patients transplanted in CR3 compared with CR2 (30% vs 75%, P ¼ 0.04). These results suggest that allo-HCT should be pursued in children after a first marrow relapse, rather than waiting for subsequent recurrence. Bone Marrow Transplantation (2011) 46, 950-955;

Allogeneic hematopoietic cell transplantation (allo-HCT) outcomes for children with B-precursor ALL and early or late BM relapse

“…[1][2][3] For instance, in our analysis, patients with an early marrow relapse treated with allo-HCT had a 5-year overall survival (OS) of 53%. 4 These results compare favorably to what has been described historically for patients receiving chemotherapy alone (5-year OS o30%). [1][2][3] Importantly, these results are consistent with other retrospective-comparison studies reporting superior outcomes for allo-HCT compared with chemotherapy in B-ALL patients with an early marrow relapse.…”

Survival Differences between Adolescents/Young Adults and Children with B Precursor Acute Lymphoblastic Leukemia after Allogeneic Hematopoietic Cell Transplantation

“…(25–29) We also found a significantly greater relapse rate in patients with MLL-R. Abnormalities of 11q23 in B-ALL have been associated with high-risk of relapse in infants (30), but there continues to be uncertainty about the prognostic significance of 11q23 identified in non-infant B-ALL. (31, 32) A large international study incorporating 11 cooperative groups and single institutions cited outcomes for non-infant MLL-R B-ALL ranging in EFS from 33 to 100% based on a variety of clinical features.…”

Factors Predictive of Relapse of Acute Leukemia in Children after Allogeneic Hematopoietic Cell Transplantation

“…Many risk factors such as disease subtype, disease status, (10, 11) conditioning regimens, (12-14) cytogenetics,(15) duration of remission and timing of transplant,(16) , (17) have been found to be independently associated with relapse, but a prognostic score incorporating these risk factors to stratify patients is lacking. Emerging data on the presence of pre-transplant minimal residual disease (MRD) as predictive of relapse is most compelling.…”